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Mixed Tension Migraine

Medically Reviewed by Melinda Ratini, DO, MS on July 16, 2020

You may have heard the terms “mixed tension headache,” :chronic daily headcahe," “chronic tension headache,” “mixed headache syndrome,” or “tension-vascular headache” before.

Experts group all of these into a syndrome called chronic daily headache (CDH). These are different kinds of headaches that happen often -- more than 15 days each month for at least 3 months. They can be migraine or tension headaches. Some come on when you take too much headache medication.

Tension Headache

This is the most common type of headache. They usually cause:

  • Steady, dull pain, often across your forehead or the back of your head
  • Tightness or pressure -- some people say it feels like you have a band across your head
  • Soreness in your scalp, neck, and shoulder muscles

Some tension headaches last 30 minutes, others can last for a week. Experts aren’t sure what causes them, but stress is a common trigger. 

Migraine Headache

If you get a migraine, you'll probably have:

  • Moderate to severe pain
  • Pounding or throbbing pain that may be on one side of your head or all over
  • Sensitivity to light, noise, and smells
  • Nausea and vomiting
  • Dizziness

Most of these type headaches last around hours, but some can stick around much longer. You might get them every day, or just one or two times a year. A visual aura (flashing lights, blind spots, or wavy lines) might happen before your headache starts. Doctors don’t know what causes them, but your genes and environment seem to play a role. Many people have a family history of migraines. Common triggers include:

  • Stress
  • Flashing or fluorescent lights
  • Chemicals
  • Caffeine
  • Changes in barometric pressure

Medication Overuse Headache

Most people take some kind of pain reliever like acetaminophen (Panadol, Tylenol), ibuprofen (Advil, Motrin, Nuprin),or naproxen (Aleve, Anaprox, Naprosyn) to treat their headaches. But if yours are ongoing, you may end up using one of these medications every day. Doing that can make things worse. You might get a "rebound headache” when the medication wears off. This happens a lot if you're using a pain reliever with caffeine or codeine.

If you have a medication overuse headache, you'll need to stop taking the pain reliever you've been using. Your doctor will tell you how to do this. Your headaches may feel worse at first. But they should get better after about a week. The doctor may prescribe other drugs to help during this time.

Diagnosing Headache Type

The doctor will ask you what your headache feels like. They'll also ask how often you get it, what you've been taking for it, and how long. You might have more than one type at the same time. If the doctor thinks some of your symptoms seem strange, they may order a CT scan or MRI.

Things to Look For

Most headaches aren’t dangerous. But they can be a sign of something serious in your brain, like bleeding or inflammation. See a doctor right away if your headache:

  • Comes on suddenly and gets really painful very quickly
  • Comes on after heavy exercise or a small injury
  • Gets worse after treatment
  • Feels really bad, different from what you felt before

Also see a doctor right away if you have these symptoms along with a headache:

  • Fever or stiff neck
  • Seizure, a personality change, or passing out
  • Weakness or numbness

Treatment

You can treat a tension headache with aspirin or other over-the-counter (OTC) pain relievers. One with caffeine may get rid of the pain quicker. try not to use them more than 9 days per month, or two doses per headache. Talk to your doctor if you’re still in pain after taking these medications.

OTC pain relievers can help with migraine pain, too, along with prescription drugs. These are usually aspirin or acetaminophen mixed with codeine or caffeine. It may also have an anti-emetic to ease nausea.

 

How to Avoid Headaches

If you have tension headaches, antidepressants called tricyclics (TCAs) may help. It's not clear how these drugs work, but they seem to ease pain when used in low doses. TCAs also can work for migraines. Your doctor might prescribe these drugs, too:

  • Beta-blockers (which lower blood pressure)
  • Calcium channel blockers (which relax the blood vessels)
  • Anti-seizure drugs

Lowering your stress level might also help. Stress can cause your body to send out certain brain chemicals that often bring on a headache. A therapist can guide you on how to better manage stress. Biofeedback training teaches you how to control your body’s responses to lower pain, like slowing your heart rate and breathing deeply. Yoga and meditation may also ease your symptoms.

Along with stress management, take these steps to keep headaches from happening:

  • Get regular sleep and exercise.
  • Drink plenty of water.
  • Eat three meals a day.
  • Cut back on alcohol, smoking, and caffeine.

Everyone has different triggers. Try to keep a headache diary to learn what triggers your headache. Write down what you were doing just before it started. What did you eat or smell? What was the weather like? This may lower the number of headaches you have and your level of pain.

WebMD Medical Reference

Sources

SOURCES:

Indian Journal of Psychiatry: "Mix headache: A valid clinical entity?"

UpToDate: "Patient education: Headache Causes and Diagnosis in Adults (Beyond the Basics)."

Mayo Clinic: "Tension Headache."

Healthbeat: "What type of headache do you have?"

Mayo Clinic: "Migraine."

National Headache Foundation: "Migraine."

National Headache Foundation: "Coexisting Migraine and Tension-Type Headaches."

The Migraine Trust: "Tension-Type Headaches."

Mayo Clinic: "Medication Overuse Headaches."

Headache: "Antiepileptic Drugs: How They Work in Headache."

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